Preparing for the Storm
Whether you’re new to the world of Applied Behavior Analysis (ABA) as a parent of a special needs child or you’re a grizzled veteran of the field; it’s hard to deny the direction in which the field is heading. It seems that Private Equity (PE) firms are attempting to corner the ABA market across the country. With this comes an increase in claims made to insurance companies that will ultimately have a negative impact on the field. Recognizing that PE firms are shaping the future of insurance-funded ABA therapy means cultivating an alternative for those who want to work outside of that system. Here are three reasons why parent should consider private pay options.
1. Target what is necessary
ABA therapy will always start with an assessment of the individual’s current level of skills in given domain areas like communication, social skills, and functional skills. If you’re child cannot tie their shoes, you will be denied by your insurance when attempting to address that skill deficit through ABA therapy. The insurance company will say that shoe-tying is the responsibility of a Physical Therapist (PT) or Occupational Therapist (OT). The problem with this distinction is that your child may have perfect motor skills, but the problem is that your child will punch you or themselves at the mere mention of shoe-tying. Now your child is working with a PT or OT, and they are not trained how to manage dangerous behavior. So, who does the other professional or parent call for help? That’s right. They call the Behavior Analyst to assist with behavior reduction. Now your insurance is paying two different professionals to teach one skill because they attempted to delineate responsibilities unnecessarily. In a private-pay model, the parent’s control (with collaboration from the Behavior Analyst) what is important for their family and child. Parents control what skills are “allowed” to be addressed and how frequently training should occur.
2. Eliminate the waitlists
ABA Therapy is currently in demand to the point where most companies have a several-week long wait list. This funnel is there the false hopes start for parents. It stands to reason that anything with a long wait is worth having. This is not necessarily true, especially with an insurance funded service. Parent A might have a child who requires 40 hours a week of intensive ABA therapy to address severe deficits in communication or social skills that could be accompanied by dangerous behavior. Parent B might have a child who is fully verbal with all the necessary age-appropriate skills, but they need some social skills training. Parent A and Parent B are now waiting in the same line when one or both could find a private-pay Behavior Analyst to deliver more immediate services while you wait for a spot to open or as the replacement for an insurance funded therapy.
3. Smaller Caseloads
One of the dark secrets of the ABA Industry is that it is built off the backs of the Registered Behavior Technician (RBT). RBTs typically very young and are not required to have a college degree to be put in a position where they are spending 40 hours a week with the most vulnerable population on the planet. ***NOTE: I HAVE WORKED WITH SOME VERY SKILLED RBTS AND THIS DOES NOT GO FOR ALL OF THEM. UNFORTUNATELY, IT GOES FOR MOST OF THEM, ESPECIALLY IN THE FIRST YEAR OF THEIR CAREER***. RBTs are trained by us, the Behavior Analyst. Behavior Analysts are often given caseloads ranging from 12-20 clients. If you have, let’s say, 15 clients all receiving 20-30 hours of ABA every week, the Behavior Analyst’s ability to address all possible training concerns is greatly diminished. Now, add an incredibly high turn-over rate on top of those issues and you have a recipe for eternal therapy with minimal progress. This is all made possible by high obligatory caseloads meant to provide a 40-hour work week for the RBTs, as the reimbursable-rate-to-hourly-payment is greater for RBTs. In a private pay model, the Behavior Analyst and the RBT are able to keep a high percentage of their billable rate and will need fewer clients to make ends meet personally. Fewer clients will lead to less burnout, higher quality services, and ultimately, better progress made by the clients.
These are the 3 most pertinent factors that I regularly think about when contemplating my career as a Behavior Analyst. Keep an eye out for the next 3.
